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    1. Announcements, meetings and other resources

      Including why this site is not for newly diagnosed low-risk men trying to select an initial treatment.


    1. Primary hormone therapy

      Early or late, long or short, intermittent or continuous, radiation or not, one or more agents (ADT1, ADT2, ADT3, ...)

    2. Secondary hormone therapy

      When primary hormone therapy fails, this may be the next step.

    3. Castrate Resistant Prostate Cancer

      CRPC - Testosterone is at castrate level, but the cancer is again advancing.

    4. Metastatic

      Evidence is found in bones or soft tissue through imaging or pain.

    5. Very high risk

      Men with very high risk may need more aggressive treatment than most. What indicates very high risk?

    6. New agents

      Drugs and other treatments of the future - under trial or newly approved.

    7. Every little bit helps

      Some drugs given for other conditions have anti-cancer effects.
      Some foods have anti-cancer effects.
      Exercise certainly helps
      An anti-prostate cancer cocktail may be in order.

    8. Radiation, diagnostic imaging, bones and other prostate cancer topics

      All types of radiotherapy, diagnostic imaging, other diagnostics and anything else on prostate cancer not covered in other forums.
      (If it's not about prostate cancer it should be in The Lounge.)

    9. Articles on other sites

      These articles are not on JimJimJimJim.com. Click on a link in one of these topics and you will be taken to another site where we have no control over what is posted.


    1. My story

      Members tell of their own history.

    2. Any suggestions?

      What should I ask my doctor about on the next visit?

    3. The lounge

      Any topic you like goes in here.
      No defamation, please.
      Nothing offensive, please.

  • Posts

    • pauldhodson
      Thanks Jim, This trial is also happening here in Oz. (See: https://www.anzup.org.au/content.aspx?page=lutetiumprostatecancertrial) I asked my MO if I could participate and I was put forward, but assessed to be ineligible as I'm responding well to Enzalutamide and my PSA in not over 20 Ug/L. I intend to get the infusions privately in any case. Cheers Paul (from Perth).
    • Admin
      Rick Indeed. Paul had four infusions.
    • ardee
      Jim - was this the trial in which Paul Hobson GRHS participated?   O&U, rd
    • Admin
      Jim Marshall (not a doctor) said ...   The problem Prostate cancer patients last much longer than most other cancer patients.   This bonus has a darker side. Men with prostate cancer have had to wait years longer to see the results of treatments tests (called clinical trials).   To take a local example, researchers led by Damien Bolton followed Victorian men who had had a radical prostatectomy between 1995 and 2000, and followed them up for about 10 years. Their report was published in 2014 (PMID: 23824175). Nineteen years! Some of the men studied can be expected to last more than 20 years - a total of twenty-nine years to see that result is anyone continues the study.   The problem has been that men and their doctors have been interested in survival - will men live longer on a treatment. And to see how many men survive and how many die, you have to wait a long time.   First solution The first solution to the problem was to try the drugs first on men who had tried everything else first. On average they should die soon-ish and you get results in only a few years.   New solution - look at scans Rathkopf and others did some research to help speed up the process. They looked at the data from a trial that had gone the full length - the PREVAIL trial. This trial had started accepting men in 2010, and published its results in 2016.    Then, for each man in the study, they looked at: how long it took for each man's scans to get worse; and how long they survived. There was a pretty good match - on average, if a man took a long time before the cancer seen on his scans got worse, he lasted a longer time.   So, this research has given us much shorter clinical study times. We don't have to wait to count heads in years to come. We just have to see if, on average, a new treatment keeps scans from getting worse longer than the best existing treatment.   Statistics - not a rule It's important to note that this works on statistics - on the average of the men's times. As usual, the group giving the average will be well spread out. So, some men with shorter times to scan worsening will actually live longer than the average. And vice versa, some unlucky men with long times to scan worsening may not live as long. Results for all prostate cancer treatments are highly individual.   New trials are happening based on this new knowledge. Decisions will be made on how well the treatment affects what show up on the men's scans.   Using this new information Two trials have looked at men whose primary hormone therapy is not holding the cancer, and their PSA is rising, but there is no sign of metastases (mets, new cancers growing away from the prostate). The PROSPER trial is looking at treating these men with Xtandi (Enzalutamide). The SPARTAN trial is looking at treating these men with Erleada (apalutamide). Both trials are looking mainly at how long a man takes to have his scans get worse.   This has already led to the FDA in the USA approving the use of Erleada (apalutamide) for men in this position, and similar approval is expected for Xtandi (Enzalutamide).   Newish guidelines for the Pharmaceutical Benefits Advisory Committee (PBAC) should make approval in Australia happen in a reasonable time. ... end Jim ============================= JAMA Oncol. 2018 May 1;4(5):694-701. doi: 10.1001/jamaoncol.2017.5808. Radiographic Progression-Free Survival as a Clinically Meaningful End Point in Metastatic Castration-Resistant Prostate Cancer: The PREVAIL Randomized Clinical Trial. Rathkopf DE1, Beer TM2, Loriot Y3, Higano CS4, Armstrong AJ5, Sternberg CN6, de Bono JS7, Tombal B8, Parli T9, Bhattacharya S10, Phung11, Krivoshik A12, Scher HI1, Morris MJ1. Author information    In Library  Abstract IMPORTANCE: Drug development for metastatic castration-resistant prostate cancer has been limited by a lack of clinically relevant trial end points short of overall survival (OS). Radiographic progression-free survival (rPFS) as defined by the Prostate Cancer Clinical Trials Working Group 2 (PCWG2) is a candidate end point that represents a clinically meaningful benefit to patients. OBJECTIVE: To demonstrate the robustness of the PCWG2 definition and to examine the relationship between rPFS and OS. DESIGN, SETTING, AND PARTICIPANTS: PREVAIL was a phase 3, randomized, double-blind, placebo-controlled multinational study that enrolled 1717 chemotherapy-naive men with metastatic castration-resistant prostate cancer from September 2010 through September 2012. The data were analyzed in November 2016. INTERVENTIONS: Patients were randomized 1:1 to enzalutamide 160 mg or placebo until confirmed radiographic disease progression or a skeletal-related event and initiation of either cytotoxic chemotherapy or an investigational agent for prostate cancer treatment. MAIN OUTCOMES AND MEASURES: Sensitivity analyses (SAs) of investigator-assessed rPFS were performed using the final rPFS data cutoff (May 6, 2012; 439 events; SA1) and the interim OS data cutoff (September 16, 2013; 540 events; SA2). Additional SAs using investigator-assessed rPFS from the final rPFS data cutoff assessed the impact of skeletal-related events (SA3), clinical progression (SA4), a confirmatory scan for soft-tissue disease progression (SA5), and all deaths regardless of time after study drug discontinuation (SA6). Correlations between investigator-assessed rPFS (SA2) and OS were calculated using Spearman ρ and Kendall τ via Clayton copula. RESULTS: In the 1717 men (mean age, 72.0 [range, 43.0-93.0] years in enzalutamide arm and 71.0 [range, 42.0-93.0] years in placebo arm), enzalutamide significantly reduced risk of radiographic progression or death in all SAs, with hazard ratios of 0.22 (SA1; 95% CI, 0.18-0.27), 0.31 (SA2; 95% CI, 0.27-0.35), 0.21 (SA3; 95% CI, 0.18-0.26), 0.21 (SA4; 95% CI, 0.17-0.26), 0.23 (SA5; 95% CI, 0.19-0.30), and 0.23 (SA6; 95% CI, 0.19-0.30) (P < .001 for all). Correlations of rPFS and OS in enzalutamide-treated patients were 0.89 (95% CI, 0.86-0.92) by Spearman ρ and 0.72 (95% CI, 0.68-0.77) by Kendall τ. CONCLUSIONS AND RELEVANCE: Sensitivity analyses in PREVAIL demonstrated the robustness of the PCWG2 rPFS definition using additional measures of progression. There was concordance between central and investigator review and a positive correlation between rPFS and OS among enzalutamide-treated patients. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01212991. PMID:   29522174   PMCID:   PMC5885186   DOI:   10.1001/jamaoncol.2017.5808 Free PMC Article
    • Claude
      My husband had 2 infusions with no results at all. The PSA went from 85 to 200 after the 1st one . We were told it is a flare up ( PSA climbing because the cancer cells died) then  to 400 after the 2sd infusion, , the bone scan showing an increase activity of the Mets, the traitment was stopped. He is now on Xtandy and the P.sa had gone down to 373 new blood test in about 2 weeks. Pain wise the traitment did very little for my husband 
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